COMPREHENSIVE EXAMINATION
AND CLINICAL REVIEW: TEST
BANK FOR CLAYTON'S BASIC
PHARMACOLOGY FOR NURSES,
19TH EDITION
SUBJECT: Advanced Nursing Pharmacology, Clinical Judgment, and Medication Safety
SOURCE MATERIAL: Clayton’s Basic Pharmacology for Nurses, 19th Edition Michelle J.
Willihnganz, Samuel L. Gurevitz, Bruce D. Clayton
DOCUMENT TYPE: Exhaustive Research Report and Examination Bank
TARGET AUDIENCE: Nursing Students, NCLEX Candidates, and Clinical Nurse Educators
OVERVIEW: This document serves as an elite-level assessment tool designed to evaluate the
depth of pharmacological knowledge required for safe nursing practice. It encompasses 55
rigorously constructed questions accompanied by exhaustive rationales and clinical
monographs. The content aligns with the 19th Edition’s emphasis on the nursing process, safety
alerts, lifespan considerations, and Next Generation NCLEX (NGN) clinical judgment standards.
UNIT I: APPLYING PHARMACOLOGY TO
NURSING PRACTICE
Question 1: Regulatory Standards and Pregnancy Labeling
Clinical Scenario: A nurse is engaged in patient education with a 28-year-old female who is 14
weeks pregnant. The patient inquires about the safety of a newly prescribed medication for her
gestational hypertension. The nurse reviews the drug label, noting that the medication was
FDA-approved in 2017. When the patient asks, "Is this a Category B or C drug?", which
response by the nurse most accurately reflects current FDA labeling standards under the
Pregnancy and Lactation Labeling Rule (PLLR)?
A. "The FDA has replaced the letter categories with a detailed risk summary that explains
potential risks to the fetus based on human and animal data, which we will review together." B.
"Since the drug was approved after 2015, it is automatically considered Category A, meaning
there are no known risks to the fetus in the first trimester." C. "The letter categories are still
used, but they are now located in the 'Females and Males of Reproductive Potential' section of
the package insert." D. "We generally assume all new drugs are Category C until proven
otherwise, so we should proceed with caution."
Answer: A
Exhaustive Rationale and Clinical Analysis: The correct answer is A. The Food and Drug
Administration (FDA) instituted the Pregnancy and Lactation Labeling Rule (PLLR), which
became effective on June 30, 2015. This rule fundamentally altered the framework for
,prescription drug labeling regarding reproductive safety, eliminating the previous A, B, C, D, and
X letter categorization system. The rationale for this shift was that the letter system was overly
simplistic and often misinterpreted as a grading system of relative safety rather than a
classification of risk based on available data. For instance, the old system often led to the
"innocent until proven guilty" bias, where newer, untested drugs (defaulting to Category B) were
perceived as safer than older drugs with known but manageable side effects (Category C).
Under the PLLR, the package insert must now contain three specific subsections: 8.1
Pregnancy, 8.2 Lactation, and 8.3 Females and Males of Reproductive Potential. Instead of
a single letter, the "Pregnancy" subsection provides a Risk Summary, which synthesizes data
from human and animal studies to describe the potential risk of adverse developmental
outcomes. It also includes Clinical Considerations, which address inadvertent exposure,
disease-associated maternal and/or embryo/fetal risk, dose adjustments during pregnancy and
the postpartum period, and maternal adverse reactions. This narrative approach forces a
dialogue between the provider and patient, allowing for an individualized risk-benefit analysis
rather than a reliance on a potentially misleading letter grade.
Distractor B is incorrect because drug approval date does not confer safety; new drugs often
have less human safety data than older ones. Distractor C is incorrect because the letter
categories have been retired entirely for new drugs, and Section 8.3 focuses on pregnancy
testing, contraception, and infertility, not on housing the old letter system. Distractor D reflects
the old "Category C" default logic, which the PLLR explicitly aims to replace with
evidence-based narratives.
Question 2: Pharmacokinetics and Pediatric Dosage Calculations
Clinical Scenario: A pediatric patient weighing 25.5 kg is prescribed ceftazidime (Fortaz) 50
mg/kg/day PO divided into three equal doses (t.i.d.). The medication is available as an oral
suspension of 125 mg/5 mL. How many milliliters (mL) should the nurse administer for a single
dose?
A. 3.4 mL B. 10.2 mL C. 17.0 mL D. 30.6 mL
Answer: C
Exhaustive Rationale and Clinical Analysis: The correct answer is C. Safe pediatric
medication administration relies heavily on accurate weight-based calculations, as children have
immature hepatic and renal systems that alter pharmacokinetics. The calculation requires a
multi-step process:
1. Calculate the Total Daily Dose: The order specifies 50 mg/kg/day. 25.5 \text{ kg} \times
50 \text{ mg/kg} = 1275 \text{ mg per day}.
2. Calculate the Single Dose: The daily dose is divided into three equal doses (t.i.d.). 1275
\text{ mg} \div 3 = 425 \text{ mg per single dose}.
3. Calculate the Volume (mL) per Dose: The available concentration is 125 mg per 5 mL.
Using the formula \frac{\text{Desired}}{\text{Have}} \times \text{Volume}: \frac{425 \text{
mg}}{125 \text{ mg}} \times 5 \text{ mL} = 3.4 \times 5 \text{ mL} = 17 \text{ mL}.
Therefore, the nurse administers 17 mL per dose.
Distractor A (3.4 mL) is the result of dividing the milligram dose (425) by the milligram
concentration (125) but failing to multiply by the vehicle volume (5 mL). Distractor B (10.2 mL)
would result if the calculation used a different concentration or weight error. Distractor D (30.6
mL) represents a calculation error where perhaps the total daily dose was not divided by three
before converting to volume. Precision in these calculations is vital; overdosing ceftazidime can
lead to neurotoxicity (seizures) or nephrotoxicity, while underdosing leads to therapeutic failure
, and antibiotic resistance.
Question 3: Controlled Substance Regulations (Schedule II)
Clinical Scenario: A nurse is educating a parent of a child newly prescribed methylphenidate
(Ritalin) for Attention Deficit Hyperactivity Disorder (ADHD). The parent asks about the
procedure for getting refills. Which response by the nurse accurately reflects the federal
regulations regarding this medication?
A. "You can get up to five refills within a six-month period before needing a new prescription." B.
"Because this is a Schedule II controlled substance, no refills are permitted; you must obtain a
new prescription for each supply." C. "I can call the pharmacy to authorize a refill whenever you
run out." D. "Refills are automatic as long as your child attends their quarterly check-ups."
Answer: B
Exhaustive Rationale and Clinical Analysis: The correct answer is B. Methylphenidate is a
central nervous system (CNS) stimulant that shares structural and pharmacological similarities
with amphetamines. Due to its high potential for abuse, diversion, and dependence, the Drug
Enforcement Administration (DEA) classifies it as a Schedule II controlled substance.
Regulations for Schedule II drugs are significantly stricter than those for Schedule III, IV, or V
drugs.
● No Refills: Unlike Schedule III and IV drugs (which can be refilled up to five times in six
months), Schedule II prescriptions cannot be refilled. A new prescription is required for
every dispensing.
● Prescription Modality: In most jurisdictions, these prescriptions must be sent
electronically via a secure, DEA-compliant Electronic Prescribing of Controlled
Substances (EPCS) system or written on tamper-resistant security paper. Verbal orders
are prohibited except in extreme emergencies (with a hard copy follow-up required within
7 days).
● Sequential Prescriptions: To manage chronic conditions like ADHD without requiring
monthly office visits, providers are permitted to issue multiple prescriptions (up to a
90-day supply total) dated on the same day but with instructions indicating the earliest
date on which they can be filled (e.g., "Do not fill until...").
Distractor A describes the regulations for Schedule III and IV drugs (e.g., benzodiazepines,
testosterone). Distractor C is incorrect because nurses generally cannot authorize refills for
Schedule II drugs, and verbal authorization is not standard. Distractor D is false; automatic
refills are strictly prohibited for this class of medication.
Question 4: Drug Actions Across the Lifespan
Clinical Scenario: An 82-year-old patient is prescribed a lipid-soluble benzodiazepine for
anxiety. The nurse anticipates that the duration of action for this drug will be prolonged in this
patient primarily due to which age-related physiological change?
A. Increased glomerular filtration rate (GFR). B. Decreased body fat composition. C. Increased
body fat proportion relative to lean mass and water. D. Enhanced hepatic enzyme activity.
Answer: C
Exhaustive Rationale and Clinical Analysis: The correct answer is C. Geriatric pharmacology
is governed by the physiological changes of aging, often summarized by the adage "Start low
and go slow." In older adults, there is a significant shift in body composition: lean muscle mass
and total body water decrease, while the proportion of body fat increases.
AND CLINICAL REVIEW: TEST
BANK FOR CLAYTON'S BASIC
PHARMACOLOGY FOR NURSES,
19TH EDITION
SUBJECT: Advanced Nursing Pharmacology, Clinical Judgment, and Medication Safety
SOURCE MATERIAL: Clayton’s Basic Pharmacology for Nurses, 19th Edition Michelle J.
Willihnganz, Samuel L. Gurevitz, Bruce D. Clayton
DOCUMENT TYPE: Exhaustive Research Report and Examination Bank
TARGET AUDIENCE: Nursing Students, NCLEX Candidates, and Clinical Nurse Educators
OVERVIEW: This document serves as an elite-level assessment tool designed to evaluate the
depth of pharmacological knowledge required for safe nursing practice. It encompasses 55
rigorously constructed questions accompanied by exhaustive rationales and clinical
monographs. The content aligns with the 19th Edition’s emphasis on the nursing process, safety
alerts, lifespan considerations, and Next Generation NCLEX (NGN) clinical judgment standards.
UNIT I: APPLYING PHARMACOLOGY TO
NURSING PRACTICE
Question 1: Regulatory Standards and Pregnancy Labeling
Clinical Scenario: A nurse is engaged in patient education with a 28-year-old female who is 14
weeks pregnant. The patient inquires about the safety of a newly prescribed medication for her
gestational hypertension. The nurse reviews the drug label, noting that the medication was
FDA-approved in 2017. When the patient asks, "Is this a Category B or C drug?", which
response by the nurse most accurately reflects current FDA labeling standards under the
Pregnancy and Lactation Labeling Rule (PLLR)?
A. "The FDA has replaced the letter categories with a detailed risk summary that explains
potential risks to the fetus based on human and animal data, which we will review together." B.
"Since the drug was approved after 2015, it is automatically considered Category A, meaning
there are no known risks to the fetus in the first trimester." C. "The letter categories are still
used, but they are now located in the 'Females and Males of Reproductive Potential' section of
the package insert." D. "We generally assume all new drugs are Category C until proven
otherwise, so we should proceed with caution."
Answer: A
Exhaustive Rationale and Clinical Analysis: The correct answer is A. The Food and Drug
Administration (FDA) instituted the Pregnancy and Lactation Labeling Rule (PLLR), which
became effective on June 30, 2015. This rule fundamentally altered the framework for
,prescription drug labeling regarding reproductive safety, eliminating the previous A, B, C, D, and
X letter categorization system. The rationale for this shift was that the letter system was overly
simplistic and often misinterpreted as a grading system of relative safety rather than a
classification of risk based on available data. For instance, the old system often led to the
"innocent until proven guilty" bias, where newer, untested drugs (defaulting to Category B) were
perceived as safer than older drugs with known but manageable side effects (Category C).
Under the PLLR, the package insert must now contain three specific subsections: 8.1
Pregnancy, 8.2 Lactation, and 8.3 Females and Males of Reproductive Potential. Instead of
a single letter, the "Pregnancy" subsection provides a Risk Summary, which synthesizes data
from human and animal studies to describe the potential risk of adverse developmental
outcomes. It also includes Clinical Considerations, which address inadvertent exposure,
disease-associated maternal and/or embryo/fetal risk, dose adjustments during pregnancy and
the postpartum period, and maternal adverse reactions. This narrative approach forces a
dialogue between the provider and patient, allowing for an individualized risk-benefit analysis
rather than a reliance on a potentially misleading letter grade.
Distractor B is incorrect because drug approval date does not confer safety; new drugs often
have less human safety data than older ones. Distractor C is incorrect because the letter
categories have been retired entirely for new drugs, and Section 8.3 focuses on pregnancy
testing, contraception, and infertility, not on housing the old letter system. Distractor D reflects
the old "Category C" default logic, which the PLLR explicitly aims to replace with
evidence-based narratives.
Question 2: Pharmacokinetics and Pediatric Dosage Calculations
Clinical Scenario: A pediatric patient weighing 25.5 kg is prescribed ceftazidime (Fortaz) 50
mg/kg/day PO divided into three equal doses (t.i.d.). The medication is available as an oral
suspension of 125 mg/5 mL. How many milliliters (mL) should the nurse administer for a single
dose?
A. 3.4 mL B. 10.2 mL C. 17.0 mL D. 30.6 mL
Answer: C
Exhaustive Rationale and Clinical Analysis: The correct answer is C. Safe pediatric
medication administration relies heavily on accurate weight-based calculations, as children have
immature hepatic and renal systems that alter pharmacokinetics. The calculation requires a
multi-step process:
1. Calculate the Total Daily Dose: The order specifies 50 mg/kg/day. 25.5 \text{ kg} \times
50 \text{ mg/kg} = 1275 \text{ mg per day}.
2. Calculate the Single Dose: The daily dose is divided into three equal doses (t.i.d.). 1275
\text{ mg} \div 3 = 425 \text{ mg per single dose}.
3. Calculate the Volume (mL) per Dose: The available concentration is 125 mg per 5 mL.
Using the formula \frac{\text{Desired}}{\text{Have}} \times \text{Volume}: \frac{425 \text{
mg}}{125 \text{ mg}} \times 5 \text{ mL} = 3.4 \times 5 \text{ mL} = 17 \text{ mL}.
Therefore, the nurse administers 17 mL per dose.
Distractor A (3.4 mL) is the result of dividing the milligram dose (425) by the milligram
concentration (125) but failing to multiply by the vehicle volume (5 mL). Distractor B (10.2 mL)
would result if the calculation used a different concentration or weight error. Distractor D (30.6
mL) represents a calculation error where perhaps the total daily dose was not divided by three
before converting to volume. Precision in these calculations is vital; overdosing ceftazidime can
lead to neurotoxicity (seizures) or nephrotoxicity, while underdosing leads to therapeutic failure
, and antibiotic resistance.
Question 3: Controlled Substance Regulations (Schedule II)
Clinical Scenario: A nurse is educating a parent of a child newly prescribed methylphenidate
(Ritalin) for Attention Deficit Hyperactivity Disorder (ADHD). The parent asks about the
procedure for getting refills. Which response by the nurse accurately reflects the federal
regulations regarding this medication?
A. "You can get up to five refills within a six-month period before needing a new prescription." B.
"Because this is a Schedule II controlled substance, no refills are permitted; you must obtain a
new prescription for each supply." C. "I can call the pharmacy to authorize a refill whenever you
run out." D. "Refills are automatic as long as your child attends their quarterly check-ups."
Answer: B
Exhaustive Rationale and Clinical Analysis: The correct answer is B. Methylphenidate is a
central nervous system (CNS) stimulant that shares structural and pharmacological similarities
with amphetamines. Due to its high potential for abuse, diversion, and dependence, the Drug
Enforcement Administration (DEA) classifies it as a Schedule II controlled substance.
Regulations for Schedule II drugs are significantly stricter than those for Schedule III, IV, or V
drugs.
● No Refills: Unlike Schedule III and IV drugs (which can be refilled up to five times in six
months), Schedule II prescriptions cannot be refilled. A new prescription is required for
every dispensing.
● Prescription Modality: In most jurisdictions, these prescriptions must be sent
electronically via a secure, DEA-compliant Electronic Prescribing of Controlled
Substances (EPCS) system or written on tamper-resistant security paper. Verbal orders
are prohibited except in extreme emergencies (with a hard copy follow-up required within
7 days).
● Sequential Prescriptions: To manage chronic conditions like ADHD without requiring
monthly office visits, providers are permitted to issue multiple prescriptions (up to a
90-day supply total) dated on the same day but with instructions indicating the earliest
date on which they can be filled (e.g., "Do not fill until...").
Distractor A describes the regulations for Schedule III and IV drugs (e.g., benzodiazepines,
testosterone). Distractor C is incorrect because nurses generally cannot authorize refills for
Schedule II drugs, and verbal authorization is not standard. Distractor D is false; automatic
refills are strictly prohibited for this class of medication.
Question 4: Drug Actions Across the Lifespan
Clinical Scenario: An 82-year-old patient is prescribed a lipid-soluble benzodiazepine for
anxiety. The nurse anticipates that the duration of action for this drug will be prolonged in this
patient primarily due to which age-related physiological change?
A. Increased glomerular filtration rate (GFR). B. Decreased body fat composition. C. Increased
body fat proportion relative to lean mass and water. D. Enhanced hepatic enzyme activity.
Answer: C
Exhaustive Rationale and Clinical Analysis: The correct answer is C. Geriatric pharmacology
is governed by the physiological changes of aging, often summarized by the adage "Start low
and go slow." In older adults, there is a significant shift in body composition: lean muscle mass
and total body water decrease, while the proportion of body fat increases.
